What Is A Migraine Cocktail: ER And At Home


What is a Migraine Cocktail?

A migraine cocktail is a combination of medications and treatments used to treat and provide relief for migraine symptoms. Usually, a migraine cocktail consists of a combination of anti-inflammatories (NSAIDs), drugs that alleviate nausea and vomiting, and medications that specifically target migraine.

You can make a migraine cocktail at home. If your migraine symptoms are serious, the doctors will administer IV migraine cocktails in the emergency room (ER) or emergency department (ED). Knowing what is a migraine cocktail can help you make better-informed medical decisions. If you are experiencing a severe migraine attack and are not finding relief from your usual treatments, you may want to visit the hospital. But first off, what is migraine?

What is Migraine?

Migraine is a neurological disease associated with headaches that can cause severe throbbing pain or a pulsing sensation, usually on one side of the head. It’s often accompanied by nausea, vomiting, and extreme sensitivity to light and sound. You may want to find out if you are experiencing these common migraine symptoms to know if you suffer from migraine.

What is in a Migraine Cocktail?

Migraine cocktail ingredients include a combination of medications and treatments to help relieve pain from the migraine attack. Common migraine cocktail ingredients consist of:

  1. Non-steroidal anti-inflammatory drugs (NSAIDs) (Advil)
  2. Acetaminophen (Tylenol)
  3. Magnesium
  4. Medications to reduce nausea or vomiting
  5. Diphenhydramine (Benadryl) to help aid with potential allergies
  6. Dihydroergotamine or IV fluids to also aid with hydration
  7. Dexamethasone: This medication is a type of steroid and reduces inflammation in the body. Research suggests dexamethasone may help prevent migraine from coming back after initial treatment.

If your migraine attack isn’t responding to your typical medications or OTC medicine or if the migraine attack lasts over 72 hours, it might be time to consider a migraine cocktail. Knowing what is in a migraine cocktail can help you identify potential migraine triggers you may have.

Migraine Cocktail At Home

Migraine Cocktails At Home With Benadryl (Diphenhydramine)

Why Is Benadryl Used For Migraine Cocktails?

Also known as diphenhydramine, Benadryl is a common migraine cocktail ingredient. It is common to use Benadryl for migraine cocktails to reduce the potential triggers or side effects associated with other migraine cocktail ingredients. This is because other migraine cocktail ingredients may cause inflammation, which is why Benadryl can help provide some relief.

Your doctor may prescribe Benadryl as a form of acute migraine medication. Interestingly, while migraine cocktails at home with Benadryl might be commonly used, research has shown that intravenous diphenhydramine (Benadryl) did not improve the intensity of acute migraine attacks in an ER or ED setting. This is surprising given that anti-histamines like Benadryl are commonly used in migraine cocktails in ER or ED for acute migraine attack treatments.

Side Effects Of Using Migraine Cocktails With Benadryl

What Are The Side Effects Of Making Migraine Cocktails With Benadryl?

Common side effects of making migraine cocktails with Benadryl include:

  • Drowsiness
  • Fatigue
  • Sedation (also known as the Benadryl effect)
  • Tolerance
  • Dry Mouth
  • Blurred vision
  • Constipation
  • Urinary retention

If you feel drowsy after consuming Benadryl, you don’t have to worry because the drowsiness will go away approximately on the 4th day. However, these side effects can affect cognitive function, impair coordination, and increase the risk of accidents or falls. If you experience these side effects of Benadryl, you should avoid driving or operating machinery.

Why Am I Drowsy After Taking Benadryl: Benadryl Effect

The Benadryl Effect is the sedating effects of Benadryl. While the exact mechanism is not fully understood, Benadryl’s sedating properties can help reduce anxiety and promote relaxation, which may contribute to pain relief in some individuals. Additionally, since migraine can be associated with hypersensitivity to sensory stimuli, Benadryl’s antihistamine effect may help alleviate any associated allergic or inflammatory responses.

However, it’s important to note that making migraine cocktails with Benadryl and its effectiveness may vary depending on individual responses and the specific formulation prescribed by healthcare professionals.

Can I Take Benadryl With Alcohol?

When you mix Benadryl (diphenhydramine) with alcohol, you experience greater sedative effects and may result in increased drowsiness, dizziness, and impaired coordination. Both Benadryl and alcohol are central nervous system depressants, and their simultaneous use can intensify these effects, potentially leading to excessive drowsiness or even loss of consciousness. When it comes to migraine cocktail medication, it is crucial to follow the instructions provided by healthcare professionals and avoid consuming alcohol while taking Benadryl or any other medication prescribed for migraines. Alcohol consumption can trigger or worsen migraines in some individuals, and combining it with medications may interfere with their intended therapeutic effects. Hence, it may not be advisable to take Benadryl with alcohol. You should be drinking alcohol at least 6 hours after you’ve taken Benadryl.

Additionally, alcohol can have interactions with other components of migraine cocktails, and it is important to prioritize safety and avoid potential adverse reactions by abstaining from alcohol consumption during treatment. Always consult with a healthcare professional for specific recommendations and guidelines regarding the use of medication and alcohol.

How Long Does It Take For Benadryl To Wear Off

The elimination half-life of Benadryl in a typical healthy adult falls within the range of 6.7 to 11.7 hours. This means that approximately half of the drug will be cleared from the body within 6 to 12 hours after taking it. After a span of two days, Benadryl will fully wear off and the entire drug will be eliminated from the body.

Migraine Cocktail With Benadryl Reddit Reviews

You can find reviews of people who made migraine cocktails with Benadryl on Reddit. Basically, many neurologist will suggest migraine patients to include Benadryl with migraine cocktails as it helps relieve sinus pressure, which may affect migraine.

Can Benadryl Help With Sinus Pressure and Sinus Headaches?

Benadryl can help lower sinus pressure and other related symptoms. Sinus pressure often occurs due to inflammation and congestion in the nasal passages, typically caused by allergies, colds, or sinus infections. As an antihistamine, Benadryl helps reduce the body’s histamine response, which can alleviate nasal inflammation and decrease sinus pressure. By blocking histamine receptors, Benadryl can help relieve stuffy or runny nose, sneezing, and sinus discomfort.

Benadryl can also help relieve sinus headaches. Sinus headaches are often caused by inflammation and pressure in the sinus cavities due to allergies, sinusitis, or sinus congestion. Benadryl, as an antihistamine, can also help reduce the body’s histamine response and minimize nasal inflammation, which can contribute to relieving sinus headache symptoms. By blocking histamine receptors, Benadryl may help reduce nasal congestion, relieve sinus pain, and alleviate the sinus headache.

Migraine Cocktails With Decadron

What Is Decadron?

Also known as Dexamethasone, Decadron is a common ingredient used in migraine cocktails for acute migraine treatment and provides relief. Some research suggests that making migraine cocktails with Decadron can effectively relieve migraine symptoms, including pain, nausea, and vomiting when Decadron is administered as an intravenous or intramuscular injection in migraine cocktails,

It is believed that migraine cocktails include Decadron because of its anti-inflammatory properties, which may help decrease the intensity and duration of migraine, leading to improved patient outcomes. However, the precise mechanisms through which Decadron exerts its effects on migraine require further exploration.

Based on research, Decadron has some side effects because it is a potent corticosteroid. Common side effects of Decadron (dexamethasone) include:

  • anxiety
  • fluid retention
  • fatigue etc
  • increased appetite
  • weight gain

Long-term use or overuse of Decadron can lead to more severe side effects, such as adrenal gland suppression and osteoporosis.

Can Decadron Help With Migraine And Headache?

The good news is that Decadron is used in migraine cocktails due to its ability to suppress inflammation and immune responses. In the context of migraine and headaches, Decadron can reduce inflammation around blood vessels and nerve fibers associated with the headache, improving the efficacy of migraine cocktails.

However, it is essential to note that migraine cocktail therapies and the inclusion of Decadron should be prescribed and supervised by healthcare professionals.

Migraine Cocktails In ER (Emergency Room) or Emergency Departments

As mentioned above, if your migraine symptoms are serious, doctors will administer a migraine cocktail in the ER (also known as emergency room/emergency departments). If a person visits the ER with severe migraine symptoms, doctors will first rule out other conditions, such as thunderclap headache symptoms. Then, they can provide several medications through an intravenous (IV) line.

Ingredients of migraine cocktails in ER include:

  • Nonsteroidal anti-inflammatory (NSAID) drugs
  • Antiemetic medications
  • Diphenhydramine (Benadryl)
  • Dexamethasone (Decadron)
  • Intravenous (IV) fluids

Sometimes, migraine cocktails in ER consist of opioids but this is only a last-resort treatment option for acute migraine attacks after all other forms of migraine cocktails are used.

Migraine cocktails in ER is effective in stopping migraine attacks. Research has shown that these treatments and migraine medications are more effective when they are given all at once in a migraine cocktail, rather than being given in stages throughout the ER visit.

Ingredients Of Migraine Cocktails In ER

Here is a list of ingredients of a migraine cocktail in ER:

  • NSAIDs, such as Ketorolac: The recommended ketorolac dosage is a 60-mg intramuscular dose or 30-mg intramuscular or intravenous (IV) doses every 6 hours (maximum daily dose of 120 mg)
  • Acetaminophen is a common ingredient for migraine cocktails in ER. It is good for migraine patients who have not taken acetaminophen in the last 4 hours and have very minor migraine symptoms. Acetaminophen is one of the active ingredients of Excedrin Migraine and is useful when combined with other NSAIDs.
  • Antiemetics: Antiemetics reduces symptoms such as nausea and vomiting. To reduce the risk of side effects, doctors may also include the antihistamine, diphenhydramine (Benadryl).
  • Triptans: Serotonin 1B or 1D agonists are often used in outpatient setting. Triptans have contraindications, and may not be effective as an ingredient of a migraine cocktail in ER setting.

Migraine Cocktail IV Ingredients

Often, migraine cocktails IV ingredients include ingredients used in ER. Common migraine cocktail IV ingredients include:

  • NSAIDs, like Ketorolac
  • Prochlorperazine
  • Diphenhydramine (Benadryl)
  • Dexamethasone (Decadron)
  • Saline solution

Ultimately, hospital migraine cocktails are administered for more severe migraine attack symptoms. According to migraine expert Dr. Jessica Kiarashi, migraine cocktails can reduce migraine symptoms within 1 hour. Doctors may add one medication consecutively, but typically, they administer several at once and research suggests this improves the outcome.

Also, IV magnesium sulfate may also help relieve migraine pain and migraine aura in the ER. Migraine aura refers to sensory disturbances some people experience before a migraine episode. A 2019 review Trusted Source indicates that IV magnesium sulfate actually works on migraine.

If the migraine cocktail does not appear to be working, doctors in ER may try other drugs, such as valproic acid, an epilepsy drug that also works for severe migraine pain in around 10–15 minutes. Epileptic drugs are considered preventive migraine medications and they can actually be used to prevent migraine as epilepsy and migraine are often linked.

IV Fluids For Migraine In ER

Despite the uncertainty of clinical evidence, around 40% of patients who come to the emergency room (ER) with a headache receive treatment involving intravenous (IV) fluids. Research conducted with healthy volunteers has demonstrated that even mild dehydration can lower the pain threshold and intensify pain-related activity in certain regions of the brain, such as the anterior cingulate cortex, insula, and thalamus (14).

Consequently, it seems reasonable to speculate that dehydration could potentially trigger sudden migraine attacks. As a result, the common practice in the ER is to administer IV fluids for migraine in addition to pain medication as a routine procedure. Clearly, the benefits of this approach would include increased patient satisfaction with the ER services due to raised pain thresholds, reduced length of stay, and decreased reliance on rescue treatment.

However, conversely, IV fluid therapy lacking apparent benefits for the patient places a financial burden on the system, consumes the time and effort of ER staff, and may prolong the patient’s stay in the ER.

Side Effects Of A Migraine Cocktail

Here are some common side effects of the migraine cocktail ingredients:

  • Side Effects Of Ketorolac: Dizziness, drowziness, nausea, tinnitus, constipation etc
  • Side Effects of IV magnesium sulfate: electrolyte imbalance, high magnesium levels
  • Side Effects of antiemetics: postural hypotension, sleepiness, restlessness etc.

Making Over The Counter (OTC) Migraine Cocktails At Home

If you find that your migraine attack is not severe enough to visit the hospital, you might consider an over-the-counter migraine cocktail or a migraine cocktail at home made with OTC migraine medications.

Migraine Cocktail At Home Ingredients

Common migraine cocktails at home ingredients include:

  • Acetaminophen, 250 milligrams (mg): It relieves pain by lowering number of prostaglandins in your body
  • Aspirin, 250 mg: Aspirin reduces pain and inflammation
  • Caffeine, 65 mg (5.5 ounces of brewed coffee)

You should consult your physician before trying any homemade migraine cocktails with over the counter drugs. The above ingredients happen to be the same active ingredients as Excedrin Migraine.

Side Effects Of Migraine Cocktails At Home

The American Migraine Foundation recommends not using OTC medications too often, even if they are highly accessible. Common side effects of migraine cocktails at home include:

  • medication overuse headaches
  • irritability and anxiety (due to OTC caffeine ingredient in the migraine cocktail)
  • abdominal pain (due to acetaminophen and aspirin)

Most OTC medicines are suspected of causing Medication Overuse Headache (MOH) if taken consistently for more than two days a week.” You can try taking a common migraine medication recommended by your doctor to assess the individual effects. For example, Excedrin is a common migraine medication for migraine patients. However, do note that these migraine cocktails might work differently as our bodies respond differently.

As mentioned earlier, the physician may prescribe other forms of migraine medications, such as CGRP inhibitors or CGRP blockers like Qulipta. There are other migraine medications, such as triptans that your doctor or neurologist may prescribe. Ultimately, if you’re at home, migraine cocktails are an alternative you can try with common medication, like Excedrin Migraine and so on.

How Often Can I Take Migraine Cocktails At Home Made With OTC Medication?

If you find yourself taking migraine cocktails at home with OTC medications more than 2-3 times a week, you should consult a doctor to assess the efficacy of the medication.

Homemade Migraine Vitamin Cocktails

As the name suggests, migraine vitamin cocktails consist of a combination of various vitamins and supplements that are commonly used to help migraine patients cope with migraine. Here are some common migraine vitamin cocktail ingredients:

  • Vitamin B12: Also known as riboflavin, Vitamin B12 may help reduce the frequency of migraines in people who are deficient in it. In a small study, people who took 400 mg of riboflavin daily for six months reported half the number of headaches per month compared to before and reduced their use of other medications. 
  • Vitamin D: Vitamin D may also be helpful in reducing the frequency of migraines, although the exact mechanism is not clear. In a study, combining vitamin D3 and simvastatin, a cholesterol-lowering drug, reduced the number of migraines per month by an average of eight to nine in people who had four to 14 migraines per month. The recommended dose is 1,000 IU twice per day, and it is generally considered safe, although it can cause various side effects when taken in excess. 
  • Magnesium: It is a mineral that is found in the body and in many foods, may be effective in reducing the frequency of migraines in people with low levels of magnesium. In a study, people who took 600 mg of magnesium daily for 12 weeks had a 41.6% reduction in the frequency of migraines during the last four weeks of the study and took fewer medications to treat their symptoms.

Ultimately, it is important to consult your migraine doctor or neurologist to assess the effectiveness of these homemade migraine cocktails, especially when you are making an OTC migraine cocktail at home. You can use a migraine diary, like Migraine Buddy to find patterns in the efficacy of the migraine cocktails.

Download Migraine Buddy now!


“Migraine Cocktails: What They Are and Why They Are Misunderstood.” American Migraine Foundation, 10 Feb. 2022, https://americanmigrainefoundation.org/resource-library/migraine-cocktail/. Accessed 27 Dec. 2022.

This article was contributed by Michelle Florero. Michelle is part of the Content Writing Team of #MBvolunteer, a volunteering initiative of Migraine Buddy. Michelle enjoys singing and hiking during her free time and uses Migraine Buddy to help manage migraine attacks. If you would like to contribute your writing or design expertise like Michelle, you can volunteer with Migraine Buddy here.

Jenny from Migraine Buddy

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